NPI | 1124725155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: CA A201780) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-02-09 |
Last Update Date | 2025-03-19 |